Society Workshop / Lab Request Form

Society Workshop / Lab Request Form

 

Requestor Name:

Requestor Email:

Association Name:

Association Website:

Exhibit/Conference Name:

Exhibit/Conference Date:

Total # of expected exhibit attendees:

Number of HCP's expected in the workshop:

Workshop Date:

Workshop Time:

Duration:

Location (Venue, City & State):

Workshop Fee:

Program Chair:

Proposed Faculty:

Will Arthrex select faculty?

Yes

No

Workshop Focus:

KneeHipShoulderElbowFoot & AnkleHand & WristArthroplastyOrthobiologicsN / A

Workshop Type:

DidacticCadaverSawbonesEquipment OnlyN / A

If equipment only, please select the type of procedure this equipment request applies to:

Open

Arthroscopy

Does your request require tower and/or video equipment with powered instruments?

Yes

No

If yes, number of stations requested:

Product Focus / Agenda:

Exclusive or joint workshop (other manufacturers represented):

Does the workshop offer CME's?

Yes

No

Will the workshop be offered during CME lecture hours?

Yes

No

Is the association registering / promoting workshop during the overall exhibit registration process?

Yes

No

If No, will the association provide a pre-registration list to Arthrex?

Yes

No

Attendee Demographics:

Is Arthrex being asked to provide food & beverage?

Yes

No